COVID-19 has brought telepractice into forefront of SLP, AUD treatment

NOTE: Our Audiology and Speech-Language Pathology clinical faculty are offering telepractice services free of charge through Aug. 6. For more information, contact us at shsclinic@illinois.edu or 217-333-2205.

The COVID-19 outbreak has radically altered life in the United States. It changed how we work, communicate, spend time with families, exercise and shop. It has also forced students to change how they learn and how they go about fulfilling the requirements of preparing for life after school.

Students in the Speech and Hearing Science Department of the College of Applied Health Sciences at Illinois have had to alter how they can complete internships, a necessary part of their coursework. Fortunately, the state of Illinois recently granted a temporary variance to allow speech-language pathology and audiology students to count telepractice hours even if the student and supervisor are not in the same room.

That decision has given students such as Nina Iraci, a first-year graduate student in the speech-language pathology program, a chance to work with clients, even if it’s via phone or video conference.

“We’ve had to be adaptable and creative in how we deliver our services,” Iraci said. “I found (telepractice) has been more of a tool than we thought. Telepractice is a great option. It’s very convenient. It’s surprised us.”

Caitlyn Boni is a second-year master’s student in SLP and her externship at an elementary school was altered by the virus outbreak, forcing her to quickly adapt to telepractice. That has allowed her to learn something about herself and her future work.

“I have learned that it is important to be a flexible clinician and be willing and prepared to improvise if needed,” she said. “Much of my service delivery was individual or one-on-one in the classroom. However, since switching to teletherapy, I have participated in more large group (classroom-level) meetings where I provide general language support to parents. The biggest change I would say is that there is much more parent involvement than would be typical in my school placement. Typically, parent collaboration is limited to IEP meetings. However, due to the extended school closures, many of the children’s’ devices have been sent home with them, and parents are becoming more oriented with their child’s device as well as how to support their child in using it to communicate.”

For Taylor Mekus, a first-year audiology grad student who has been working to create educational videos about audiology and hearing health during the shelter-in-place order, has also found telepractice to be surprisingly effective.

“I did not realize how expansive telepractice can be, but being faced with this scenario the field of Audiology seems to be coming up with new and exciting ways to deliver services via telepractice,” she said. “We always have to be adaptive to change and find new ways to help our patients.”

Monique Dang is a second-year audiology grad student, and she has been working closely with Clark-Lindsay Village, focusing on hearing loss in adults, whether it’s noise-induced or age-related hearing loss. Last semester—also known as BC (Before COVID-19)—she worked to get the Audiology Clinic service into Clark-Lindsey to perform monthly cleanings and checks of the residents’ hearing aids. That’s been put on hold, forcing the clinic to “to move to alternative avenues of care,” she said.

“We have worked to connect with our hearing aid patients and express our availability virtually in this difficult time,” Dang said. The clinic—which is offering its services free—is troubleshooting hearing aids, walking through care and maintenance and offering other adjustments, Dang said. “I’m learning this transition to telepractice is a learning curve,” she said.

CHANGE AND CHALLENGES

As Dang mentioned, the transition to telepractice doesn’t come without its challenges. For one, the students miss working directly with their clients. “It goes without saying that I just miss human interaction in general,” Iraci said, “but another thing that’s a challenge is if we need to do any sort of manual manipulation, any sort of oral mechanism examination, that’s pretty difficult.”

Hannah Smith, a second-year audiology grad student, said the main obstacle was lack of prep time.

“As students, teaching assistants, research assistants, and clinicians, we had approximately one week to prepare for an online transition for the remainder of the semester,” she said. “This proved to be very difficult and time consuming for the first few weeks and required a lot of creative problem-solving skills to navigate these unknown waters.”

Dang agreed.

“(Telepractice) requires trial and error, and a lot of planning and collaborative efforts. Simply put, it’s not at all the same as providing traditional face-to-face services,” she said. Technology is part of the problem, she said, as well as trying to set up group appointments at a time when that is being discouraged.

“Our elderly patients seem reluctant to use technology,” Taylor added, “so we are facing the challenge of helping patients to step out of their comfort zone and utilize technology.”

Still, Taylor said, patience was vital.

“We need to consider that working with technology in order to utilize telepractice may be more of a learning curve for them. We have to remember since our patients have hearing loss, communicating via video call may be more difficult and we will have to adapt to each individual circumstance.”

The obstacles are not only associated with the elderly. For Boni, working with children has had its share of issues.

“It can be difficult to provide therapy in a way that will keep the child engaged and willing to participate in the session,” she said. “It is very helpful to have a parent nearby to provide behavior management since it is nearly impossible for me to do via teletherapy. For example, after five minutes of therapy a child said to me, ‘OK, I’m done with speech. BYE!’ and ran away from the screen. Luckily, her mom intervened and brought her back to the session.”

TELEPRACTICE HERE TO STAY?

Despite the trials of telepractice, the budding practitioners see the advantages in a post-COVID-19 world.

“Telepractice is a great thing, especially during this time and when it comes to trying to provide appropriate access to care to those in rural communities,” Dang said.

Boni said patience and understanding is needed, but she definitely sees the benefits.

“Telepractice can provide unique opportunities that may not be possible with typical face-to-face sessions,” she said. “Some things are difficult, but with a little creativity it is possible to find a work-around to most challenges and I do believe my clients are benefiting from teletherapy.”

Smith agreed.

“Telepractice initially may seem rather intimidating, however, from my personal experience, patients have really enjoyed the convenience and quick turnaround of services,” she said. “We are moving into an ever-changing technology-centered society so patients who are interested in that are embracing telepractice services from the comfort of their own home. Telepractice will continue to develop and improve so it is very exciting to see how this will impact the way in which we serve our patients.”

An added benefit is that the Audiology and Speech-Language Pathology Clinic is not charging clients for its telepractice service through Aug. 6.

Iraci believes telepractice has a place, even after the COVID-19 threat is extinguished.

“Telepractice is a great option, especially for adults, because they’re typically very busy and only have time for a moment of teletherapy, in their car, or on a break at any time. It’s very convenient.

“It would be a great service for our clinic to provide, regardless of the stay-home order.”